Overview
We all know what it’s like to feel full and bloated. Usually, it happens after we eat too much, and within an hour or two, the symptoms go away. But if you find yourself feeling full after eating just a small amount of food and have frequent stomach pain, bloating, or heartburn—or if you often feel nauseous, it’s a good idea to see a doctor. You may have an uncommon stomach disorder called gastroparesis.
Also known as delayed gastric emptying, gastroparesis is a condition in which the passage of food from the stomach to the small intestine is slowed. As a result, food remains in the stomach for longer than normal, which can lead to nausea, vomiting, bloating, and stomach pain, among other symptoms.
Gastroparesis can affect people of any age. It is more common in females than in males, and among people with type 1 and type 2 diabetes.
Fortunately, several treatments are available that can help to reduce symptoms and improve quality of life.
What is gastroparesis?
When a person eats, food enters the stomach where enzymes and acid begin to digest it. Muscles in the stomach contract to further break down the food into tiny pieces and propel it through the stomach and into the small intestine where digestion continues and nutrients are absorbed into the body.
In people with gastroparesis, the muscles in the stomach work slowly (or are weak) and are unable to effectively move food to the small intestine in a timely way. Food stays in the stomach for longer than normal, causing symptoms. In severe cases, gastroparesis can result in difficulty absorbing essential nutrients from foods, key ingredients from medications, as well as dehydration.
What are the causes of gastroparesis?
Gastroparesis is often caused by damage to nerves that stimulate the stomach muscles to contract. These large and small nerves play an important role in controlling the muscles in the stomach that are involved in moving food out of the stomach to the small intestine.
While a number of medical conditions have been linked to gastroparesis, in nearly 4 out of 10 cases, doctors are unable to determine what caused the disorder. This is known as idiopathic gastroparesis.
Causes of gastroparesis include:
- Diabetes. About 30% of gastroparesis cases are associated with diabetes.
- Viral infection. Certain viruses, including norovirus and rotavirus, have been linked to gastroparesis.
- Medications. Various medications, including calcium channel blockers, opiates, and progesterone, can slow the movement of food through the stomach.
- Surgery. Surgical procedures may damage the vagus nerve, impairing the function of the muscles in the stomach.
- Autoimmune gastrointestinal dysmotility (AGID). AGID is an autoimmune condition in which the nerves that control muscles in the stomach are damaged, reducing their ability to propel food through the stomach.
- Neurological disorders. Parkinson’s disease, multiple sclerosis, and other neurological disorders have been linked to gastroparesis.
Other conditions, including amyloidosis and scleroderma, have also been linked to gastroparesis.
What are the symptoms of gastroparesis?
Symptoms of gastroparesis may include:
- Nausea
- Vomiting
- Bloating
- Feeling full soon after starting to eat or long after finishing a meal
- Belching
- Pain in the upper abdomen
- Heartburn
- Unexplained weight loss
- Lack of appetite
How is gastroparesis diagnosed?
To diagnose gastroparesis, your doctor will review your medical history, perform a physical exam, and order one or more diagnostic tests.
As a first step, your doctor will ask about your symptoms and whether you have any medical conditions associated with gastroparesis. During the physical exam, your doctor will closely examine your abdomen and look for signs of malnutrition and dehydration.
Additional tests are necessary to make a diagnosis. They may include:
- Imaging tests, including a nuclear medicine gastric emptying test and/or an upper GI series (X-rays of the upper gastrointestinal tract).
- Upper gastrointestinal endoscopy, a test in which a thin tube equipped with a camera and a light is inserted into the mouth and down to the esophagus, stomach, and upper part of the small intestine. This allows doctors to examine the inside of the upper gastrointestinal tract. It’s important to note that this test is not part of the diagnostic criteria but often will be done to evaluate symptoms at some point in the diagnostic journey.
Doctors may also perform tests that measure how fast the stomach empties after eating, including:
- Gastric emptying scintigraphy (GES). In this test, the patient eats a small meal containing a small amount of a radioactive substance. A radiologist then uses a special scanner to track the passage of the radioactive substance through the stomach. This is the most widely used test for diagnosing gastroparesis.
- Wireless motility capsule (WMC). The patient swallows a small capsule equipped with electronics that allows doctors to track its passage through the stomach and other parts of the GI tract.
What are the treatments for gastroparesis?
Treatments for gastroparesis include:
- Diet. Initial treatment often involves dietary changes, including:
- Eating soft, well-cooked foods that are low in fat and fiber (fat and fiber are the most challenging foods for the stomach to break down)
- Eating 5-6 small meals per day
- Drinking plenty of fluids
- Avoiding carbonated drinks, alcohol, and tobacco
- Going on a liquid diet (for those who have difficulty eating solid foods)
- Taking liquid multivitamins, which may help prevent vitamin deficiencies
Those who are unable to eat enough to maintain nutrition may need to receive food through a feeding tube that is inserted into the nose or mouth and directed down to the stomach and small intestine. In some cases, the feeding tube may be inserted in the stomach or small intestine. In other cases, patients receive nutrition intravenously.
- Blood glucose control (for people with diabetes). High blood glucose levels may slow stomach emptying and worsen symptoms. Maintaining good control of blood glucose levels may reduce symptoms.
- Medications. Various medications are used to treat gastroparesis, including:
- Prokinetics. These medications stimulate muscles in the stomach to propel food forward, improving stomach emptying.
- Antiemetics. These medications help reduce symptoms of nausea and vomiting. They don’t improve stomach emptying.
- Neuromodulators. Some medications work on the level of nerve communication by modifying the amounts of serotonin, norepinephrine, and dopamine to relieve nausea, vomiting, and stomach pain.
- Withdrawal of offending medications. For example, the ones mentioned previously; removing medicines that slow gut motility can improve symptoms.
- Surgery. If gastroparesis symptoms don’t improve sufficiently with dietary modification and medications, surgery may be an option.
- Gastric peroral endoscopic myotomy (G-POEM). In G-POEM, an endoscopist inserts an endoscope—a thin tube equipped with a camera, light, and surgical instruments—into the patient’s mouth and guides it into the stomach. The surgeon then creates a small cut in the pylorus to improve stomach emptying. It is less invasive than a pyloroplasty, a procedure that cuts the pylorus, the muscular valve that opens to allow food to pass from the stomach to the small intestine.
- Gastric electrical stimulation (GES). In GES, a mechanical device implanted into the abdominal wall sends electrical impulses to the stomach muscles via two leads, stimulating the muscles to contract and push food through the stomach to the small intestine. The device must be surgically implanted under the skin in the abdomen.
What are the complications of gastroparesis?
- Gastroesophageal reflux disease (GERD)
- Malnutrition
- Dehydration
- Electrolyte imbalance
- Bezoars (masses of undigested food, hair, and other materials in the stomach that can cause blockages in the digestive tract)
What is the outlook for people with gastroparesis?
The outlook depends on several factors, including the cause of the disorder. For instance, gastroparesis cases that develop due to a viral infection often go away relatively quickly after symptom onset, whereas once it develops, diabetic gastroparesis is usually a lifelong condition. Gastroparesis that arises from other causes can also be a chronic, long-term condition.
While medications and other treatments typically cannot cure the disorder, they can provide relief from symptoms. Because gastroparesis is usually a chronic disorder, people with the condition often need long-term treatment, as well as periodic follow-up appointments with their doctor to monitor how well treatments are working.
What stands out about Yale Medicine's approach to gastroparesis?
Yale's Gastrointestinal Motility Program works with patients who suffer with symptoms of gastroparesis to find individualized treatment plans that work for them,” says Yale Medicine gastroenterologist Jill Deutsch, MD. “The more we understand about this disorder, the more we know that it falls along a spectrum of disease that requires a unique approach for every person. We offer the full gamut of interventions, including multidisciplinary care coordination with nutrition, consultation with therapeutic endoscopists, surgeons, as well as endocrinologists, and access to cutting-edge medications and diagnostic examinations.”
